Hiatus Hernia as a Complication of Gastric Banding: A Systematic Review and Meta-Analysis

Worsening hiatus hernia (HH) symptoms have been well recognized as a complication of gastric banding, however, it has not yet been explored whether gastric banding plays a role in the development of HH de novo in patients undergoing gastric banding. From the 696 studies identified, five studies met the eligibility criteria and were included. Data was extracted from PubMed, Embase, Medline, HMIC, and Web of Science databases. The pooled complication rate was evaluated along with 95% confidence intervals (95% CIs). The meta-analysis was performed using the Cochrane RevMan tool (Cochrane, London, UK). Heterogeneity was tested using the I² index for each outcome. All the included studies assessed HH incidence among followed-up patients who needed a re-operation for upper gastrointestinal symptoms. Between-study variability was high (I² = 94%, Chi² = 68.92, df = 4, < 0.00001, Tau2=1.91). Complication rate ranged between 0.24% to 5.55%; pooled complication rate was 2.17% CI 95% (0.90 - 3.44%) P = 0.0008. The included studies show a comparable rate of post-operative HH; the fact that HHs can become symptomatic following the adjustable gastric banding (AGB) procedure indicates that AGB plays a role in creating symptomatic hiatal hernias at the very least. Further research is needed to underpin the mechanism and confirm causation. However, this complication should potentially be discussed with patients opting for this kind of operation as it can be a reason for re-operation.